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February 17, 2020

New Home Health Patient-Driven Groupings Model (PDGM) Tool

Under the home health Patient-Driven Groupings Model (PDGM), each of the 432 case-mix groups has a threshold to determine if the period of care would receive a Low Utilization Payment Adjustment (LUPA). Currently, the LUPA threshold ranges between 2 and 6 visits. A RAP is not required for LUPA periods of care; however, it is more challenging to predict when a period of care will result in a LUPA since it’s based on variable thresholds.

To help you determine the visit threshold, the Home Health Low Utilization Payment Adjustment (LUPA) Threshold Calculator was developed based on the CMS CY 2020 PDGM Case Mix Weights and LUPA ThresholdsZip File. Simply enter the HIPPS code, click Search, and the therapy visit threshold will display.

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